Fig 2. Histopathological findings observed in pulmonary muscular arteries showed variable degrees of arterial media and intima remodeling. (A) Intima (triangles) and media (arrowheads) thickening, hyaline membranes were observed within alveolar septa (hematoxylin and eosin [HE], × 100)). (B) media layer (arrowheads) thickening (HE, ×100). (C) media layer (arrowheads) thickening and diffuse hyaline membrane formation(arrows) in the alveolar space were observed (HE, ×100). (D&E) minor thickening of muscular pulmonary arteries(HHF 35, ×100) (F) media (arrowheads) thickening (HE ×200).
As for cardiac pathological changes, the volume of heart was larger, no significant abnormalities were observed in the exiting or entering great vessels of the heart. All the cases had large PDA and PFO, with a mean diameter of DA 4.6 mm. The average wall thickness of RV was 2.6 mm. Microscopic examination showed turbid swelling of muscle fibers and lytic degeneration of some muscle fibers. There were no significant inflammatory cell infiltration and myocardial cell necrosis. No epicardial changes were observed.
From the hepatic findings, 7 cases showed herniation, liver abnormalities were observed in the unoperated group, significant impression was observed in the herniated part of the liver tissue, and the liver texture was slightly solid. Marked congestion was noted. Microscopic observation showed that normal structure of hepatic lobule was present, and hepatocytes were obviously swollen and degenerated. The sinusoids were markedly dilated and congested with bleeding in some areas. Marked extramedullary hematopoiesis was seen. Focal inflammatory cell infiltration was observed in the portal area, with significant dilatation and congestion of small vessels.
The structure of the diaphragm was absent in the ipsilateral side, while muscle fiber tissues in contralateral side were normal. Striated muscle tissue was still observed in the periphery of defect side. Diaphragm separated by delicate fibrovascular connective tissue either devoid of muscle or with only a few skeletal muscle fibers present in congenital eventration (Fig 1 H). Focal chronic inflammatory cell infiltration was found in operated cases and one of them had significant dilated congestion and calcification necrosis (Fig 1 I).
Two patients had accessory splenic malformation, one had thymic dysplasia and the others showed no significant abnormalities.
Table 2. Histological findings in patients who died from CDH